County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis

ABSTRACTThis study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China...

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Main Authors: Tao Zhang (Author), Jing Liu (Author), Xiaohe Wang (Author), Chaojie Liu (Author)
Format: Book
Published: Taylor & Francis Group, 2023-12-01T00:00:00Z.
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001 doaj_d67a80f9f3f54be9bfd16ed76ee55e2e
042 |a dc 
100 1 0 |a Tao Zhang  |e author 
700 1 0 |a Jing Liu  |e author 
700 1 0 |a Xiaohe Wang  |e author 
700 1 0 |a Chaojie Liu  |e author 
245 0 0 |a County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis 
260 |b Taylor & Francis Group,   |c 2023-12-01T00:00:00Z. 
500 |a 10.1080/23288604.2023.2258770 
500 |a 2328-8620 
500 |a 2328-8604 
520 |a ABSTRACTThis study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China. A quasi-experimental design was adopted, involving 6 hospitals from 2 counties in the intervention group and 12 hospitals from 5 counties in the control group. The DRGs-based payments for inpatient care and capitation funding for outpatient care were introduced in January 2018 and January 2019, respectively. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms using monthly data over the period from January 2017 to December 2019. The volume of inpatient care decreased after the introduction of the first-stage DRGs-based payments, which was accompanied by an increase in the volume of outpatient visits. The DRGs-based payments led to a reduction of on average 1390 Yuan total expenditure per episode of inpatient care and 1116 Yuan out-of-pocket (OOP) payment per episode of inpatient care. However, the average outpatient expenditure per visit increased. So did the corresponding OOP payment per outpatient visit. The introduction of the second-stage capitation funding for outpatient care reversed the increasing trend of outpatient care. The average expenditure and OOP payment per outpatient visit decreased. The funding reforms create a significant effect on service volumes and expenditures in county hospitals. A coordinated approach to both inpatient and outpatient funding mechanisms is needed to minimize cost-shifting between inpatient and outpatient care and to achieve the intended policy outcomes. 
546 |a EN 
690 |a Capitation 
690 |a China 
690 |a DRGs 
690 |a interrupted time series analyses 
690 |a public hospitals 
690 |a Medicine (General) 
690 |a R5-920 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n Health Systems & Reform, Vol 9, Iss 1 (2023) 
787 0 |n https://www.tandfonline.com/doi/10.1080/23288604.2023.2258770 
787 0 |n https://doaj.org/toc/2328-8604 
787 0 |n https://doaj.org/toc/2328-8620 
856 4 1 |u https://doaj.org/article/d67a80f9f3f54be9bfd16ed76ee55e2e  |z Connect to this object online.